Group Forms

Group Forms


Please follow the directions closely.

People interested in speaking at Suffolk County Correctional Facilities must email a request for a Facility Pass to the Corrections Chair at The email MUST include:

  1. a SCANNED copy of your license
  2. completed Facility Pass form

There are a two of prerequisites
  1. you can not have any outstanding warrants
  2. you can not have been in either facility for the last 12 months

Please indicate for which facility you are requesting a pass.

  • Riverhead Jail
  • Yaphank Facility

The Facility Pass form is an EDITABLE PDF

To fill out:
  1. Click on the link
  2. Complete form on the screen
    1. NAME
    2. DATE
    3. ADDRESS
    4. DOB
    5. SS #
    6. CELL #
    8. PURPOSE ,,,”should say A.A.”
  4. Hit Ctrl-S to save the completed form
  5. Remember the location where you saved the form
  6. Attach the completed form and a copy of your license to the email
The inmates are in need of speakers as often as permissible and you are doing a huge service to these individuals by volunteering your time, strength, hope and experience. Thank you!
Format File
Corrections Facility Pass

SIA Hotline

To update your group’s 12 Step contact information:
    • FAX the completed form to 631-654-1110

Phone Captains can use the following form to sign up group members for shifts during their group’s week:

AA Grapevine

Click here to go to AA Gravine Store front

Adobe Acrobat Reader

Click here to download Adobe Acrobat Reader

Meeting List / Group Information Update Form

To avoid miscommunications, we kindly ask that you use the Meeting List / Group Information Update form found below.

See sample below to learn how to use the form !!

Please fill in ALL information, old and new, in a legible fashion please.

To fill out the Microsoft Word document:
  1. Click the link for the MS Word Format and save to your computer.
  2. Open the downloaded file with Microsoft Word.
  3. Fill out the form.
  4. Save the form to your local drive.
  5. Email the Word document as an attachment to ‘
To fill out PDF form:
  1. Click the link for the PDF Format below and save to your computer.
  2. Open the downloaded file with Adobe Acrobat Reader.
  3. Select Tool / Fill Sign-In
  4. Fill in the form.
  5. In Windows, save the form. On a Mac, print it as a pdf document and save the print file to your local drive.
  6. Open the saved file in Adobe Acrobat Reader to make sure the information has been saved.
  7. If the information is still intact, email the PDF file as an attachment to ‘
  8. If the information has been lost, print the form, fill in the information, then either scan and email the completed form as above or mail it to Meeting Chair, P.O. Box 659, Patchogue, New York 11772.
Format File
MS Word 93-2006 Meeting List Group Update Form
PDF Format Meeting List Group Update Form